Provider Demographics
NPI:1972001980
Name:RODRIGUEZ, LUIS JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2216
Mailing Address - Country:US
Mailing Address - Phone:209-349-2437
Mailing Address - Fax:
Practice Address - Street 1:89 EMERALD DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2216
Practice Address - Country:US
Practice Address - Phone:209-349-2437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA814161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical